Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Levothyroxine Therapy in Elderly Patients With Hypothyroidism

Research output: Contribution to journalReviewResearchpeer-review

  1. Editorial: Proglucagon-Derived Peptides

    Research output: Contribution to journalEditorialResearchpeer-review

  2. Prevalence of Pathogenic Germline DICER1 Variants in Young Individuals Thyroidectomised Due to Goitre - A National Danish Cohort

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Impact of a Parastomal Bulge on Quality of Life - A Cross-sectional Study of Patients From the Danish Stoma Database

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Brain tumours in children and adolescents may affect the circadian rhythm and quality of life

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Brain tumours result in sleep disorders in children and adolescents

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves’ disease

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.

Original languageEnglish
Article number641560
JournalFrontiers in Endocrinology
Volume12
Pages (from-to)641560
ISSN1664-2392
DOIs
Publication statusPublished - 12 Mar 2021

    Research areas

  • elderly, hypothyroidism, levothyroxine, older adults, thyroid, thyroid treatment

ID: 65610680